Strasserking Fiona E, Musho Jane, Heimburger Douglas C, Mutale Wilbroad, Damp Julie A, Mumba Ngosa, Goma Fastone
Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Cardiovascular Medicine and Office of Global Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Int J Cardiol Heart Vasc. 2022 Aug 22;42:101104. doi: 10.1016/j.ijcha.2022.101104. eCollection 2022 Oct.
Peripartum cardiomyopathy (PPCM) disproportionately affects women of African descent, however knowledge about this disease in African countries is limited.
To describe the phenotype of women with PPCM seen at a referral hospital in Zambia and examine outcomes at 6 months.
A prospective observational study describing characteristics and 6-month outcomes was performed at the University Teaching Hospital Echocardiography Lab in Lusaka, Zambia.
We enrolled 45 participants with PPCM and 38 were seen at 6-month follow up; 3 (7 %) died and 4 (9 %) were lost to follow up. Mean age was 32.9 years (SD:7.0); mean BMI was 25.3 kg/m (SD:4.1), mean parity was 3.4 (SD:2.2) children and twin pregnancies occurred in 4 (9 %). Median time from symptom onset to diagnosis was 60 days (IQR: 1-280). 20 (44 %) reported gestational hypertension and 10 (22 %) reported preeclampsia. Baseline median left ventricular ejection fraction (LVEF) was 36 % (IQR: 11-45), median left ventricular end-diastolic volume (LVEDV) was 150 mL (IQR: 58-229) and 79 % described New York Heart Association (NYHA) functional class IV symptoms. Median LVEF after 6 months was 49 % (IQR: 23-68; < 0.001) and median LVEDV was 121 mL (IQR: 66-200; < 0.001). At 6-month follow up 45 % had LVEF ≥ 50 %, 42 % had LVEDV ≤ 106 mL and 1 (3 %) had NYHA functional class IV symptoms.
Hypertension was prevalent in this cohort. Overall mortality rate was low and clinically significant improvements in cardiac parameters were seen in over 40%. Further research is needed to identify and mitigate gaps in diagnosis and management.
围产期心肌病（PPCM）对非洲裔女性的影响尤为严重，然而非洲国家对这种疾病的了解有限。
描述赞比亚一家转诊医院中患有PPCM的女性的表型，并检查6个月时的结局。
在赞比亚卢萨卡大学教学医院超声心动图实验室进行了一项前瞻性观察性研究，描述其特征和6个月时的结局。
我们纳入了45例PPCM患者，38例在6个月随访时接受检查；3例（7%）死亡，4例（9%）失访。平均年龄为32.9岁（标准差：7.0）；平均体重指数为25.3kg/m（标准差：4.1），平均产次为3.4个孩子（标准差：2.2），4例（9%）为双胎妊娠。从症状出现到诊断的中位时间为60天（四分位间距：1-280）。20例（44%）报告有妊娠期高血压，10例（22%）报告有先兆子痫。基线时左心室射血分数（LVEF）中位数为36%（四分位间距：11-45），左心室舒张末期容积（LVEDV）中位数为150mL（四分位间距：58-229），79%的患者描述有纽约心脏协会（NYHA）IV级功能症状。6个月后的LVEF中位数为49%（四分位间距：23-68；P<0.001），LVEDV中位数为121mL（四分位间距：66-200；P<0.001）。在6个月随访时，45%的患者LVEF≥50%，42%的患者LVEDV≤106mL，1例（3%）有NYHA IV级功能症状。
该队列中高血压很常见。总体死亡率较低，超过40%的患者心脏参数有临床显著改善。需要进一步研究以识别和缩小诊断与管理方面的差距。
